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Sutureless Pars Plana Anterior Vitrectomy Through Self-Sealing

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Sutureless Pars Plana Anterior Vitrectomy Through Self-Sealing CASE REPORTS AND SMALL CASE SERIES (Figure 1). The mass was vividly platelets) and to 6000000 U/wk in Interferon alfa Therapy red and contained prominent inter- and after the third week. The iris tu- Against Metastatic Iris nal blood vessels. Satisfactory visu- mor began to regress about 3 weeks Tumor of Renal Cell alization of the entire right fundus after the beginning of interferon alfa was not possible because of insuffi- administration, and it appeared to- Carcinoma cient mydriasis, but a retinal detach- tally regressed and white after 16 ment was noted in the periphery be- weeks (Figure 1). The retinal de- Ocular metastasis of renal cell carci- tween the 3- and 7-o’clock positions. tachment disappeared, and the ul- noma is rare, and metastasis to the iris B-scan ultrasonography revealed a trasonographically demonstrated tu- or ciliary body is especially uncom- ciliary body mass at the inferonasal mor in the ciliary region was not mon. Ferry and Font1 studied 227 part of the ciliary body. No abnor- detected. However, the tumor me- cases of metastatic tumors of the eye mality was noted in the left eye. tastasized to the lung, liver, and and orbit and reported that 26 Systemic examination re- bones thereafter, and the patient died (11.5%) of these lesions were iris or vealed swelling of the cervical lymph on June 20, 1993. ciliary body tumors and that 2 (0.9%) nodes, and results of computed to- originated in the kidney. We exam- mographic scans and magnetic reso- Comment. Renal cell carcinoma ac- ined a patient with an iris tumor that nance images of the head disclosed counts for 80% to 85% of the ma- metastasized from a renal cell carci- a cerebral tumor in the right occipi- lignant tumors of the kidney.2 Me- noma and observed marked effects of tal lobe. Biopsy of the cervical lymph tastases were reported to be present interferon alfa administration. nodes established lymph node me- in 25% to 30% of patients with re- tastasis of the renal cell carcinoma nal cell carcinoma at the initial ex- Report of a Case. A 55-year-old man (Figure 2). Because neurological amination.2 Metastases of renal cell was seen on September 3, 1992, with symptoms such as disturbance of carcinoma are hematogenous and a 1-week history of decreased vi- consciousness appeared thereafter, lymphogenous, and the lungs are the sion in his right eye. His history in- the brain tumor was resected on Oc- most frequent site of the distant me- cluded radical right nephrectomy for tober 8, and the tumor was con- tastases, followed by metastases to renal cell carcinoma in December firmed histopathologically to be a bones, liver, and brain.2 Metastases 1990 and left partial pneumonec- metastasis of the renal cell carci- to the eye are rare, and those to the tomy due to lung metastasis in June noma. iris have been documented in only 1992. Systemic interferon alfa was a few cases, including those re- The corrected visual acuity was started on October 23 for conserva- ported by Ferry and Font1 and Wy- 20/20 OU and the intraocular pres- tive treatment of the iris tumor. The zinski et al.3 The iris tumor of our sure was 11 mm Hg OU. Slitlamp dose was set initially at 21000000 patient appeared vividly red through biomicroscopy showed cells in the U/wk, but it was reduced to the biomicroscope (Figure 1). This anterior chamber and a well- 9000000 U/wk in the second week color has been recognized by some circumscribed solid tumor (8 3 4 due to bone marrow suppression clinicians as characteristic of many mm) in the iris of the right eye (decrease in white blood cells and metastatic ocular tumors from re- Figure 1. Left, A well-circumscribed solid tumor, which appeared vividly red and contained prominent internal blood vessels, is observed on the iris between the 3- and 7-o’clock positions. Right, The tumor appeared to be totally regressed and white 16 weeks after the beginning of interferon alfa administration. (REPRINTED) ARCH OPHTHALMOL / VOL 118, JUNE 2000 WWW.ARCHOPHTHALMOL.COM 846 ©2000 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 ists included number of years since completion of clinical training and complexity of the detachment.2 Complications of pneumatic retinopexy have been well de- scribed and involve the anterior and posterior segments.3,4 These in- clude: cataract, choroidal detach- ment, delayed resorption or shifting of subretinal fluid, endophthalmi- tis, pars plana/subconjunctival/ subretinal gas, malignant glaucoma, peripheral subretinal hemorrhage, vitreous hemorrhage, iris incarcera- tion, macular hole/pucker, neck pain, subretinal/vitreous pigment, prolif- erative vitreoretinopathy, refractive changes, untreated retinal breaks, Figure 2. Light microscopic appearance of lymph node metastasis displaying sheets of uveitis, vitreous incarceration/loss, polyhedral-shaped cells with clear cytoplasm (hematoxylin-eosin, original magnification 3100). and central retinal artery occlu- sion.3,4 Self-sealing, clear corneal inci- nal cell carcinoma. Our patient was Miyakojima-ku, Osaka 534-0021, sions for cataract extraction have be- treated conservatively because no re- Japan (e-mail: [email protected]). come increasingly popular recently duction of vision or secondary glau- owing to the combined advantages 1. Ferry AP, Font RL. Carcinoma metastatic to the coma due to the tumor was noted, eye and orbit, II: a clinicopathological study of of phacoemulsification, foldable in- and because the prognosis was poor 26 patients with carcinoma metastatic to the an- traocular lenses, and topical anes- due to multiple organ metastases. terior segment of the eye. Arch Ophthalmol. 1975; thesia.5 Wound strength was one of 93:472-482. Renal cell carcinoma resists rou- 2. Motzer RJ, Bander NH, Nanus DM. Renal-cell the early criticisms of this tech- tine chemotherapy and radiother- carcinoma. N Engl J Med. 1996;335:865-875. nique, although studies suggest that 2 3. Wyzinski P, Rootman J, Wood W. Simulta- apy. However, since interferon alfa neous bilateral iris metastases from renal cell car- the integrity of small incision, clear has recently been reported to have a cinoma. Am J Ophthalmol. 1981;92:206-209. corneal incisions is comparable with direct antiproliferative effect on re- 4. Nanus DM, Pfeffer LM, Bander NH, Bahri S, Al- traditional limbal or scleral based in- 4 bino AP. Antiproliferative and antitumor ef- 5 nal tumor cells in vitro, and to stimu- fects of alpha-interferon in renal cell carcino- cisions. Typically, self-sealing clear late host mononuclear cells and mas: correlation with the expression of a kidney- corneal incisions are reinforced via enhance the expression of major- associated differentiation glycoprotein. Cancer stromal hydration at the end of the Res. 1990;50:4190-4194. histocompatibility-complex mol- procedure, and sutures can be used ecules,2 it has been introduced as a to enhance wound integrity. new treatment for renal cell carci- The 2 cases in which clear cor- noma. More recently, the effects of neal incisions from recent cataract interferon alfa when used in combi- Clear Corneal Cataract surgery dehisced during pneu- nation with interleukin 2 and fluo- Wound Dehiscence During matic retinopexy. To our knowl- rouracil, or with 13-cis-retinoic acid, Pneumatic Retinopexy edge, this potentially dangerous have been evaluated.2 The response complication of pneumatic retino- rate of patients to interferon alfa alone Pneumatic retinopexy is generally pexy has not been reported previ- is considered to be about 20%, and accepted as a safe and effective treat- ously. However, it may become in- its therapeutic effect is limited when ment for certain types of retinal de- creasingly common given the it is used alone. However, as some pa- tachment. This procedure recently growing popularity of clear corneal tients such as ours show marked has been demonstrated to produce cataract extraction and the in- responses, interferon alfa may be use- equivalent final visual outcomes and creased risk of retinal detachment ful in patients with intraocular me- reattachment rates compared with imparted by intraocular surgery and tastases of renal cell carcinoma. scleral buckling for primary rheg- pseudophakia. matogenous retinal detachment.1 Tomohiro Ikeda, MD The growing popularity of this tech- Report of Cases. Case 1. A 49-year- Keiko Sato, MD nique was verified in a recent sur- old white man underwent clear cor- Takanobu Tokuyama, MD vey of members of the Retina and nea cataract extraction and poste- Osaka, Japan Vitreous Societies that revealed that rior chamber intraocular lens pneumatic retinopexy is the treat- implantation in the left eye on June Corresponding author: Tomohiro ment of choice for “uncompli- 11, 1999. The procedure was com- Ikeda, MD, Department of Ophthal- cated” retinal detachments.2 Fac- plicated by a small tear in the pos- mology, Osaka City General Hospi- tors influencing the selection of this terior lens capsule at the 4-o’clock tal, 2-13-22, Miyakojimahondori, modality by vitreoretinal special- position, which did not require an- (REPRINTED) ARCH OPHTHALMOL / VOL 118, JUNE 2000 WWW.ARCHOPHTHALMOL.COM 847 ©2000 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 terior vitrectomy. The corneal sentially normal posterior segment in tesis may be performed prior to gas wound was closed with a single 10-0 the left eye. On August 19,1998, fol- injection to minimize a rapid in- polyglactin (Vicryl) suture, and the low-up examination revealed a small, crease in IOP. Alternatively, smaller wound was watertight at the con- rhegmatogenous retinal detach- volumes of injected gas may be used clusion of the operation. The post- ment superonasally in the left eye for pneumatic retinopexy per- operative course was uneventful un- arising from a retinal break at a pre- formed in the setting of recent clear til June 23, 1999, when the patient vious sclerotomy site.
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